Active NPI
Kathryn Elizabeth Jacques Frodermann, PA-C
- Medical Physician Assistant
- Robbinsdale, MN
National Provider Identifier
1245564343
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 9772
- Practice address
- 3366 Oakdale Ave N
Suite 315
Robbinsdale, MN 55422 - Phone
- (763) 587-7900
- Fax
- (763) 587-7989
- NPI assigned
- Sep 23, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 9772 | MN | Primary |
Addresses
Primary practice location
3366 Oakdale Ave N
Suite 315
Robbinsdale, MN 55422
Mailing address
9201 West Broadway Ave
Suite 601
Brooklyn Park, MN 55445
Phone (763) 587-7900
Other names 1
- Kathryn Elizabeth Jacques
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9772 | MN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Clinic, PA | Past | Accepting new patients | |
| Colon & Rectal Surgery Associates LTD | Past | Accepting new patients | |
| Pelvic Floor Center, LLC | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Colon & Rectal Surgery Physician
- Minneapolis, MN
- NPI 1376596775
-
dba Voyage Healthcare
- Multi-Specialty Clinic/Center
- Brooklyn Park, MN
- NPI 1407011760
-
- Colon & Rectal Surgery Physician
- Minneapolis, MN
- NPI 1538107743
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428624000000",
"number": "1245564343",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9201 WEST BROADWAY AVE",
"address_2": "SUITE 601",
"city": "BROOKLYN PARK",
"state": "MN",
"postal_code": "55445",
"telephone_number": "763-587-7900",
"fax_number": "763-587-7066"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3366 OAKDALE AVE N",
"address_2": "SUITE 315",
"city": "ROBBINSDALE",
"state": "MN",
"postal_code": "55422",
"telephone_number": "763-587-7900",
"fax_number": "763-587-7989"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRODERMANN",
"first_name": "KATHRYN",
"middle_name": "ELIZABETH JACQUES",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-09-23",
"last_updated": "2015-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "MN",
"license": "9772",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KATHRYN",
"last_name": "JACQUES",
"middle_name": "ELIZABETH",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Robbinsdale, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.